Advocacy & Compliance

Healthesystems’ Advocacy & Compliance experts are essential in the management of pharmacy and ancillary benefits for our clients. By tracking and influencing regulatory activity, our team stays ahead of evolving trends and identifies opportunities to advocate on behalf of our clients, their injured workers, and the broader industry.

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The Advocacy &  Compliance Team

Monitors and reports on proposed and pending regulatory changes that impact workers' comp, helping shape effective program strategies

Advocates for fair and balanced public policy through proactive engagement with regulators, customers, and other stakeholders throughout the rulemaking lifecycle

Supports operational compliance by providing guidance to internal stakeholders and external partners during the implementation of new regulatory changes

Regulatory Recap

A weekly e-newsletter informed by the Advocacy & Compliance team to help keep our clients and industry contacts in the know on the latest legislation and policy updates impacting workers’ comp.

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Advocacy Opportunity

Nevada Proposes Changes to Provider Panel Rules

Payers could soon be required to change certain reporting processes.

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October 7, 2024

Treatment Guidelines

New York PT & OT Assistants Can Soon Treat Injured Workers

Effective October 27th, these professionals can treat injured workers under the supervision of a Board-authorized provider.

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October 7, 2024

Claim Costs Pharmacy Data

Delaware Workers’ Comp Trends

A new WCRI report reviews claim costs, medical payments, prescription payments, and more.

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October 7, 2024

Technology

California Enacts AI Disclaimer Bill and AI Utilization Review Bill

Providers will have final approval of UR decisions when AI is used, and patients must receive notice if AI is used to generate claims communications.

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October 7, 2024

Worker Safety

California Vetoes Heat Presumption for Farmworkers

Governor Gavin Newsome stated that heat safety enforcement falls under Cal/OSHA, not workers’ comp.

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October 7, 2024

Opioids

Fair Health Releases New Opioid Tracker Tool

Based on 48 billion commercial healthcare claim records, this tool tracks opioid abuse and dependence.

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October 7, 2024

Industry Data Opioids

NCCI Opioid Webinar

NCCI found opioid utilization to be decreasing while opioid doses remained high.

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September 30, 2024

Cost Containment

Texas Releases 2025 Audit Plan

Audits will focus on timely and accurate reimbursement, bill reporting, and delivery of benefits.

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September 30, 2024

Treatment Guidelines

California Vetoes UR Doctor Licensing Bill

Doctors performing utilization review for private employers will not have to be board certified.

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September 30, 2024

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Further resources you may be interested in

Additional articles and updates from Healthesystems related to policy shaping workers’ comp.

Polypharmacy: How Many Drugs is Too Many?

A claims professional noted that a patient’s drug regimen included 11 medications, raising serious concerns.

Myth Busters: Private-Label Topicals Edition

Private-label topical (PLT) analgesics are independently manufactured lotions and creams that are increasingly being prescribed to patients for the temporary relief of minor pain associated with injury.